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	<div class="span-19 container">
	<h1>VIH Gestante - Codigo INS 860</h1><hr/>
    <form id="evento_850" action="" method="post">
    	<fieldset>
			<legend>Seguimiento inicial</legend>
				<table>
					<tr>
						<td>
							<label>Momento de diagn�stico de VIH</label>
	      		  			<select id="tipodoc" name="tipodoc">
	    					  <option value="c">Antes del embarazo actual</option>
	    					  <option value="r">Despu�s del embarazo actual</option>
	    		  			</select>
						</td>
					</tr>
				</table>
    	</fieldset>
    	<fieldset>
			<legend>Reportes</legend>
			
    	</fieldset>
		
	</form>
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